Healthcare Provider Details

I. General information

NPI: 1720647167
Provider Name (Legal Business Name): PRIMROSE MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SANTA ANITA AVE STE 300
ARCADIA CA
91006-3116
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 300
ARCADIA CA
91006-3116
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-1806
  • Fax: 626-380-2342
Mailing address:
  • Phone: 626-821-1806
  • Fax: 626-380-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLEN CHEN
Title or Position: CEO
Credential: MD
Phone: 626-823-1684